Provider Demographics
NPI:1619739778
Name:NORTHCUTT, WALTER (LPC)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:
Last Name:NORTHCUTT
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1745 KESWICK RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-5623
Mailing Address - Country:US
Mailing Address - Phone:580-716-9700
Mailing Address - Fax:
Practice Address - Street 1:225 E CHEYENNE MOUNTAIN BLVD STE 220
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-3700
Practice Address - Country:US
Practice Address - Phone:719-900-2256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0019883101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health